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Archives of Orthopaedic and Trauma Surgery

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31-01-2023 | Hip-TEP | Orthopaedic Surgery

Influence of kinematics of the lumbopelvic complex in hip arthroplasty dislocation: from assessment to recommendations

Authors: Pascal Kouyoumdjian, Jad Mansour, Stanislas Marouby, Francois Canovas, Louis Dagneaux, Remy Coulomb

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2023

Abstract

Introduction

In total hip arthroplasty (THA), misplacement of the implant can provide instability. Adequate orientation of the acetabular cup is a challenge due to variations in inter-individual anatomy and kinematics of the pelvis in everyday life. The aim of this study was to characterize the kinematic factors influencing the risk of dislocation in order to give recommendations for optimal placement of the cup. We hypothesized that the lack of pelvic adaptation would influence the risk of prosthetic instability and motivate adapted.

Materials and methods

Eighty patients with primary unilateral THA were included in a matched case–control study. Seventy-four patients were divided into two groups: group 1 (G1) consisting of patients with postoperative THA dislocation (37 patients) and group 2 (G2), without episodes of dislocation within two years postoperatively (37 patients). In both groups, spino-pelvic parameters and cup orientation were measured in standing and sitting positions with EOS^® X-ray imaging and compared to each other between 12 and 24 months post-operatively.

Results

No significant difference between the two groups was found for static parameters. In a sitting position, a lack of pelvic retroversion with a significant lower variation in sacral slope was observed in group 1 (8.0° ± 9.3 for G1 versus 14.7° ± 6.2 for G2, p < 0.01). Twenty-two (59%) patients with THA instability had sacral slope variations of less than 10° versus eight (21% of patients) with stable THA (p < 0.01). Cup orientation in the Lewinnek safe zone was not significantly different (59% vs 67%, p = 0.62), and the spino-pelvic parameters and cup orientation measured did not change between the standing and sitting positions. However, only 14 (37%) cups in G1 were in the functional safe zone versus 24 (67%) in G2 (p = 0.03).

Conclusion

Static parameters of the sagittal spinopelvic balance have a low predictive value for prosthetic instability. Dynamic analysis is essential. Kinematic parameters must be taken into account in determining the ideal position of the cup or stem. Stiffness with locked standing or sitting pelvis must be integrated in order to determine a personalized safe zone.

Level of evidence

Level III (matched case–control study).

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Title: Influence of kinematics of the lumbopelvic complex in hip arthroplasty dislocation: from assessment to recommendations
Authors: Pascal Kouyoumdjian
Jad Mansour
Stanislas Marouby
Francois Canovas
Louis Dagneaux
Remy Coulomb
Publication date: 31-01-2023
Publisher: Springer Berlin Heidelberg
Keywords: Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2023
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-022-04722-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Influence of kinematics of the lumbopelvic complex in hip arthroplasty dislocation: from assessment to recommendations

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

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